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Dr Amer Jafar. Early Dementia After First-Ever Stroke From 1985 to 2008, overall first-ever strokes occurring within the population of the city of Dijon,

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Presentation on theme: "Dr Amer Jafar. Early Dementia After First-Ever Stroke From 1985 to 2008, overall first-ever strokes occurring within the population of the city of Dijon,"— Presentation transcript:

1 Dr Amer Jafar

2 Early Dementia After First-Ever Stroke From 1985 to 2008, overall first-ever strokes occurring within the population of the city of Dijon, France (150 000 inhabitants) were recorded The presence of dementia was diagnosed during the first month after stroke, according to Diagnostic and Statistical Manual of Mental Disorders

3 Over the 24 years, 3948 first-ever strokes were recorded. Among patients with stroke, 3201 (81%) were testable of whom 653 (20.4%) had poststroke dementia (337 women and 316 men) The prevalence of poststroke dementia associated with lacunar stroke was 7 times higher than that in intracerebral haemorrhage but declined over time as did prestroke antihypertensive medication

4 Age, several vascular risk factors, hemiplegia, and prestroke antiplatelet agents were associated with an increased prevalence of poststroke dementia

5 Cerebral Microbleeds Predictive of Mortality in the Elderly To investigate the prognostic value of cerebral microbleeds (CMB) regarding overall, cardiovascular- related, and stroke-related mortality Authors included 435 subjects who were participants from the nested MRI substudy of the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER)

6 Subjects with >1 CMB had a 6-fold risk of stroke- related death compared to subjects without CMB Conclusion: the diagnosis of microbleeds is potentially of clinical relevance Larger studies are needed to expand our observations and to address potential clinical implications

7 Predict Stroke Outcome A 5-Item Scale Predict Stroke Outcome After Cortical Middle Cerebral Artery Territory Infarction The authors retrospectively reviewed 129 patients over a 2-year period and considered demographic, clinical, laboratory, and radiographic parameters as potential predictors of outcome.

8 Inclusion criteria were unilateral hemispheric infarcts within the middle cerebral artery territory >15 mm in diameter The primary outcome measure was a favourable recovery defined as a modified Rankin Score was 2 at 30 days

9 The 5 independent predictors of outcome were as follows: Age National Institutes of Health Stroke Scale score infarct volume admission white blood cell count presence of hyperglycemia

10 this model serves as a useful clinical and research tool to predict stroke recovery after cortical middle cerebral artery territory infarction.

11 Stenting and Endarterectomy The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) data were analyzed to determine safety in symptomatic and asymptomatic patients. CREST is a randomized trial comparing safety and efficacy of CAS versus CEA in patients with high-grade carotid stenoses

12 For 1321 symptomatic and 1181 asymptomatic patients, the periprocedural aggregate of stroke, myocardial infarction, and death did not differ between CAS and CEA The stroke and death rate was higher for CAS versus CEA

13 Conclusions: There were no significant differences between CAS versus CEA by symptomatic status for the primary CREST end point Periprocedural stroke and death rates were significantly lower for CEA in symptomatic patients

14 Thrombolysis Acute ischemic stroke patients who receive recombinant tissue plasminogen activator (rt-PA) within 3 hours of symptom onset are 30% more likely to have minimal to no disability at 3 months retrospective analysis of all patients with ischemic stroke who presented within the original three hour window for intravenous thrombolysis, and who were admitted to the University of Texas Houston Medical School Stroke Service

15 Out of 2225 patients with acute ischemic stroke, 1019 were discharged to home, 719 to inpatient rehabilitation, 371 to a skilled nursing facility and 116 to subacute care Conclusion: Patients who receive intravenous recombinant tissue plasminogen activator as treatment for acute ischemic stroke are more likely to be discharged directly home after hospitalization

16 Deep Vein Thrombosis Prophylaxis Patients with intracerebral hemorrhage (ICH) are at high risk for development of deep venous thrombosis. Current guidelines state that low-dose subcutaneous low molecular weight heparin or unfractionated heparin may be considered at 3 to 4 days from onset

17 insufficient data exist on hematoma volume in patients with ICH before and after pharmacological deep venous thrombosis prophylaxis The authors identified 73 patients with a mean age of 63 years and median National Institutes of Health Stroke Scale score 11.5

18 The mean baseline total hematoma volume was 25.8 mL±23.2 mL Repeat analysis of patients given pharmacological deep venous thrombosis prophylaxis within 2 or 4 days after ICH found no increase in hematoma size Pharmacological deep venous thrombosis prophylaxis given subcutaneously in patients with ICH and/or intraventricular hemorrhage in the subacute period is generally not associated with hematoma growth

19 Sulfonylurea Use Before Stroke Sulfonylureas block nonselective cation channels and lower serum glucose and are neuroprotective in animal models of ischemic stroke Human data on sulfonylureas in acute stroke are sparse and conflicting aimed to measure the potential neuroprotective effect of prestroke sulfonylurea use in diabetic patients

20 The authors analyzed data from a prospective cohort of individuals with diabetes mellitus (DM) enrolled in nonreperfusion ischemic stroke trials within Virtual International Stroke Trials Archive (VISTA) comprising 1050 patients, 298 with sulfonylurea use before stroke onset

21 The primary outcome measures were baseline National Institutes of Health Stroke Scale score and 90-day modified Rankin Scale score Compared with patients on no DM medications, those with sulfonylurea use before stroke onset presented with less severe stroke but had similar modified Rankin Scale scores at 90 days

22 Sulfonylurea use before stroke onset did not affect stroke severity or long-term functional outcome compared with other DM treatments This finding casts doubt on the use of sulfonylureas for prophylactic neuroprotection. Furthermore, patients not using any medication for DM appear to have more severe strokes and worse outcomes

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